Stem Cell Therapy Could Boost Kidney Transplant Success: Study

TUESDAY, March 20 (HealthDay News) — A novel technique that
uses a kidney transplant recipient’s own stem cells may someday replace or
reduce the initial use of anti-rejection medications, new research
suggests.

Six months after receiving a kidney transplant, only about 8 percent of
people given their own mesenchymal stem cells experienced rejection
compared with almost 22 percent of people on the standard anti-rejection
drugs, according to the study.

“Mesenchymal stem cells are stem cells that can be differentiated into
a variety of cells,” explained Dr. Camillo Ricordi, study senior author
and director of the Cell Transplant Center and Diabetes Research Institute
at the University of Miami Miller School of Medicine.

“If you infuse mesenchymal stem cells at the time of the transplant,
you could replace the use of powerful anti-rejection drugs, and maybe
replace immunosuppressants altogether,” he said. This technique could be
used in the transplantation of islet cells (in the pancreas) for people
with type 1 diabetes, and for other organ transplants, such as the liver,
he added.

The people given their own stem cells also had improved kidney function
earlier after transplant, Ricordi said.

Results of the study appear in the March 21 issue of the Journal of
the American Medical Association
.

One of the biggest remaining hurdles in organ transplantation remains
the need for powerful anti-rejection and immune-suppressing medications
after the transplant.

“Basically, the way we prevent kidney rejections is by putting you on
very powerful anti-rejection drugs and immunosuppressive agents to prevent
your cells from attacking the foreign organ,” said Dr. Robert Provenzano,
chair of the department of nephrology, hypertension and transplantation at
St. John Providence Health System in Detroit. “But, the current standard
has some problems, like an increased risk of infections and the
possibility of creating a cancer.”

The body’s immune system sends out surveillance cells to protect the
body against foreign invaders, such as a bacteria, virus or, in this case,
a new organ, Provenzano said. The current method of preventing these cells
from attacking the new organ is essentially to destroy the surveillance
cells. But mesenchymal cells can naturally suppress those surveillance
cells so they don’t attack, he said.

To see if this suppression would be enough to prevent rejection,
Ricordi and his colleagues, including researchers from Xiamen University
in China, recruited 159 people with serious kidney disease who were on
dialysis. They ranged in age from 18 to 61.

The study participants all had medically well-matched relatives willing
to donate a kidney for transplant.

Each was randomly assigned to receive one of three treatments after
transplant. One group got standard treatment with anti-rejection
medication (induction therapy) and immune-suppressing medication known as
calcineurin inhibitors (CNIs). Another group was infused with their own
stem cells and the standard dose of CNIs, while the final group received
stem cells plus a lower dose of CNIs (80 percent of the standard dose).

Survival rates for the patients and their new kidney were similar for
all three groups at 13 to 30 months, the study found.

But before that, at six months, nearly 21.6 percent of those on
standard therapy experienced rejection, compared with 7.5 percent of the
stem cell plus standard CNIs, and 7.7 percent in the stem cell plus
low-dose CNIs.

Both groups who received stem cells recovered kidney function faster
than those on standard therapy. And at one year, the researchers found
that the risk of opportunistic infections was reduced by nearly 60 percent
in those who got the stem cell treatment.

Provenzano expressed enthusiasm for the new procedure. “I see this as
the continued evolution of transplant medicine. It’s very exciting to be
able to use your own natural cells instead of more toxic medications,” he
said. He added that more studies are needed to confirm these findings and
study long-term effects, but said “the data here appears promising.”

Some experts are less impressed. “This is a novel technique, but I
don’t think it would be regarded as a significant step forward. It was
only significant at six months,” said Dr. Glyn Morgan, the associate
director of transplantation at NYU Langone Medical Center in New York
City. And, he added, “It’s only a change in the induction protocol.
Primary immunosuppressant agents are still used long term.”

Other researchers have also been testing the use of stem cells in
transplants. The March 7 issue of Science Translational Medicine
reported on an attempt to transfer stem cells from the donor to the
transplant recipient before transplant, in an attempt to create a hybrid
immune system that would accept the new organ. Five of eight patients
studied haven’t needed medications to suppress their immune systems,
according to the study.

Ricordi said perhaps a combination of stem cell therapies might lead to
even more effective immune suppression.

More information

Learn more about the immune-suppressing medications used after a kidney
transplant from the National Kidney Foundation.

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